Archived: The Fountains Nursing Home

The Fountains Nursing Home is a residential care home providing personal and nursing care for up to 98 people. At the time of our inspection there were 71 people living at the home. Accommodation is provided in three separate units. Victoria unit (general nursing) is situated on the ground floor and both Lowry (dementia nursing) and Garden View (residential) are situated on the first floor.

People’s experience of using this service and what we found

Since our last inspection some improvements had been made to the management of medicines. However, further improvements are needed, particularly around medicines administration records and ‘when required’ medicines. We have made a recommendation about the safe management of medicines.

There were systems in place to ensure only staff who were suitable to work with vulnerable people were recruited. There were enough staff to care for people and people told us they felt safe and happy living at The Fountains Nursing Home. Staff understood safeguarding procedures and had received training in recognising the signs of and types of abuse.

The home was clean, well-maintained and nicely decorated. All servicing of equipment had been completed. Staff followed correct infection control practices.

Risks to people’s health and safety had been assessed and were managed correctly. A variety of appropriate activities were provided, and people were actively encouraged to participate in them.

Since our last inspection improvements had been made in record keeping and in the quality assurance systems. People had person-centred care plans in place and staff were knowledgeable about people’s needs.

There was good oversight of the service, with effective systems in place to monitor the quality of support provided and to drive improvements. We discussed the concerns we found around medicines management with the registered manager and steps were immediately taken to rectify some of the issues.

People and staff were complimentary about the way the home was managed. There was an open and honest culture at the service and the registered manager showed committed leadership. Staff told us they all worked well together as a team.

Rating at last inspection and update

The last rating for this service was requires improvement (report published 8 November 2019).

We carried out an unannounced comprehensive inspection of this service on 7, 8 and 12 August 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe, responsive and well-led, which contained those requirements.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. The ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Fountains Nursing Home on our website at www.cqc.org.uk.

The Fountains Nursing Home is owned and managed by SPV4 Limited and is situated in the Swinton area of Salford, Greater Manchester. The accommodation is provided in three separate units. Victoria unit (General Nursing) is situated on the ground floor and both Lowry (Dementia Nursing) and Garden View (Residential) are situated on the first floor.

The home is registered with the Care Quality Commission (CQC) to provide care for up to 98 people. Car parking is available at the home in sufficient quantities.

People’s experience of using this service:

We carried out this comprehensive inspection on 7,8 and 12 August 2019. At the time of the inspection there were 85 people living at the home.

Improvements were required to the safe administration of people’s medication, record keeping and quality assurance systems. Breaches of the regulations were identified regarding safe care and treatment and good governance.

Not all staff felt the management team were approachable and supportive. We raised these issues with the provider who told us they would investigate this further and raise the issue at future staff meetings.

People said they felt safe living at the home, with staff demonstrating a good understanding about how to protect people from the risk of harm.

Staff were recruited safely, with appropriate checks carried out before their employment commenced.

Maintenance checks of the premises and the servicing of equipment was carried out throughout the year to ensure they were safe to use.

There were enough staff to care for people safely, although some of the feedback received from staff was that more were required on each of the units.

Accidents and incidents were monitored and any actions taken to prevent future re-occurrence were recorded.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests.

Staff received the necessary training and support to help them in their roles. Staff supervisions and appraisals were carried out and gave staff the opportunity to discuss their work.

We saw staff supporting people at meal times, if they needed assistance. Where people needed modified diets due to having swallowing difficulties, these were provided. Feedback about the food provided was mixed however.

People living at the home and visiting relatives made positive comments about the care provided at the home. The feedback we received from people we spoke with was that staff were kind and caring towards people.

People said they felt treated with dignity and respect and that staff promoted their independence as required.

Complaints were handled appropriately. Compliments were also maintained about the quality of service provided.

Activities were available for people to participate in if they wanted to. One to one activities also took place where people were cared for in bed.

Rating at last inspection:

Our last inspection of The Fountains Nursing Home was in June 2018. The overall rating at that inspection was ‘Requires Improvement’. The report was published in August 2018. Requirement notices were issued following breaches of the regulations regarding person centred care, safeguarding people from abuse and improper treatment and staffing.

Enforcement:

At the last inspection we issued two warning notices regarding safe care and treatment and good governance.

Why we inspected:

This inspection was carried out in line with our inspection methodology timescales for services rated Requires Improvement. This meant we needed to re-inspect within 12 months following the publication of the last report.

Follow up:

We will continue to monitor information and intelligence we receive about the home to ensure good quality care is provided to people. We will return to re-inspect in line with our inspection timescales for ‘Requires Improvement’ rated services, however if any further information of concern is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The Fountains Nursing Home is owned by SPV4 Limited . The home is situated in large grounds overlooking Victoria Park and is close to Swinton town centre. The home provides both residential and nursing care for up to 98 people who require personal care for both physical and mental health related illnesses. The home consists of four units, known internally as Victoria (General Nursing), Lowry (Nursing Dementia), Garden Rooms (General Residential) and Park View (Residential Dementia). At the time of the inspection there were 89 people living at the home.

The Fountains Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

This was the first inspection we had carried out at The Fountains Nursing Home, since the provider, SPV4 Limited purchased the home and registered with CQC in October 2017.

During this inspection we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 with regards to person centred care, safe care and treatment, safeguarding people from abuse and improper treatment, good governance and staffing. We have also made a recommendation regarding responding to information received in satisfaction surveys. You can see what action we have asked the home to take at the end of this report.

People living at the home did not always receive their medication safely. We found two instances (one on Park View and one on Garden Rooms) where staff had signed on the medication administration record (MAR) that medicines had been given, however the medication was still in the blister pack. Drink thickening supplements such as thick and easy were not stored securely and were accessible in cupboards on Park View unit and could place people at risk of harm.

People were placed at risk of skin break down because equipment such as pressure relieving mattresses were not at the correct settings. This was predominantly on Victoria unit.

We noted several environmental risks, again on Victoria unit, which could place people at risk. These included sluice room doors being left unlocked with keys in the door, meaning cleaning products could be accessed and place people at risk of harm. Areas of concern identified during the last fire risk assessment were not being acted on and we observed fire doors being held open with a drinks trolley and wedged with people’s slippers. This meant the door would not close properly in the event of a fire. Corridors on Victoria unit were cluttered with hoists and wheelchairs and could affect people’s exit in an emergency situation.

People living at the home said they felt safe and staff had a good understanding about how to safeguard people from abuse. We were informed about one incident where a member of staff had reported concerns to the manager about how another member of staff had behaved towards a person living at the home, as they felt this was being done in a threatening manner. This had not been reported as a safeguarding incident to the local authority. This was subsequently sent following our inspection.

We found there were not enough staff deployed to effectively meet people’s needs on Park View Unit, particularly at meal times. We observed staff were unable to assist people with tasks such as mobilising around the unit due to supporting people who needed full support to eat and drink.

We looked at the safety and suitability of the premises. A refurbishment plan was in progress at the time of our inspection and we observed several of the units had new carpets, chairs and window frames. The Lowry unit was still in need of refurbishment in many areas and we will monitor the progress of this work at our next inspection to ensure it has been carried out in line with the set time scales.

Effective systems were not always in place with regards to deprivation of liberty safeguards (DoLS) and the Mental Capacity Act 2005 (MCA).

People told us they received enough to eat and drink and we observed people receiving appropriate assistance from staff during the inspection at meal times. We saw people had been appropriately referred to services such as speech and language therapy (SALT) and dieticians if their were concerns about their nutritional status. Advice and guidance was not always well recorded however, such as if people had received prescribed supplements or milky drinks to help them maintain a healthy weight.

People did not always receive care that met their needs outlined in their care plan.

Accurate and contemporaneous records were not always being maintained in relation to people’s care needs.

We have made a recommendation within the detailed findings of the report about ensuring information from satisfaction surveys is acted upon and clearly documented.

Audit and quality assurance systems were in place, however needed to be improved to ensure concerns found during this inspection were identified and acted upon in a timely manner.

Some of the feedback we received from staff was that they felt management and nursing staff were not supportive and approachable.

Staff were recruited safely, with appropriate checks carried out before they commenced employment.

Safety checks of areas including electrical installation, gas safety, legionella and hoists had been carried out, with any remedial work/recommendations acted upon.

Staff told us they received sufficient induction, training and supervision to support them in their role. Appraisals had not yet been carried out under the new provider and we were told these had been scheduled to be completed following our inspection.

People living at the home told us they were happy with the care they received, as did any visiting relatives we spoke with. People said they felt treated with dignity, respect and were given privacy when they needed it.

Complaints were handled appropriately, with a response provided where people had expressed any concerns about the service provided.

A range of different activities were available for people to take part in if they wished.

Meetings took place for staff, people living at the home and relatives so they could discuss and contribute towards the running of the home.